A Clinician’s View on Pre-chronic Obstructive Pulmonary Disease/Pre-non-obstructive Chronic Bronchitis: A Quest for More Research on Early Diagnosis and Treatment

Current criteria for the diagnosis of chronic obstructive pulmonary disease (COPD) result in its relatively late detection, typically when the disease is well established.Cough, excessive sputum production and shortness of breath are not signs of an impending disease, but rather symptoms of a well-established disease.This review hypothesizes that earlier detection of a pre-stage of COPD (hereinafter referred to as Pre-COPD) enables earlier treatment and the elimination of identifiable provoking factors resulting in improved outcomes by starting treatment before the disease is established.Several criteria are proposed for the diagnosis of Pre-COPD or NOCB (pre-non-obstructive chronic bronchitis).These criteria include frequent and/or unusually prolonged respiratory tract infections, especially with bacterial superinfection, and notable findings during chest auscultation.To be useful at the forefront of patient care, the diagnosis of Pre-COPD should be straightforward and independent of a cost-intensive laboratory or technical support.Using the criteria outlined here, the diagnosis can be made globally, as it requires only the patient's history and an experienced healthcare worker.If future studies show an acceptable positive and negative predictive value of the proposed criteria, and that proposed actions such as enhanced physical activity and infection prevention are effective, the diagnosis and management of Pre-COPD could be introduced into guidelines as an entirely prophy-